作者：高天理

单位：

100029 北京市，首都医科大学附属北京安贞医院

Units：

Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China

关键词：

缺血性脑卒中；静脉溶栓；阿替普酶；指南

Keywords：

Acute ischemic stroke; Intravenous thrombolysis; Alteplase; Guidebooks

CLC：

R 743.33

DOI：

10.12114/j.issn.1008-5971.2021.00.150

Funds：

摘要：

　2021年2月《欧洲卒中组织（ESO）急性缺血性脑卒中静脉溶栓指南》（以下简称2021版ESO指南）发布， 其全面系统地总结了急性缺血性脑卒中静脉溶栓（IVT）治疗的最新研究进展，2021 版ESO 指南是对2008 版《缺血 性脑卒中和短暂性脑缺血发作治疗指南》的更新，共48条推荐意见，提供了不同患者亚组、超时间窗、影像学选择策略、 阿替普酶和替奈普酶的相对和绝对禁忌证的进一步建议，新增了对醒后卒中或症状发作时间不明患者选择IVT 治疗的 推荐。本文对2021 版ESO 指南主要更新内容和推荐进行解读，主要包括症状发作时间＜ 4.5 h 的急性缺血性脑卒中患 者的阿替普酶IVT 治疗、症状发作时间4.5~9.0 h 的急性缺血性脑卒中患者的阿替普酶IVT 治疗、IVT 治疗药物及剂量、 合并用药，以期借鉴和学习欧美的经验，推动我国急性缺血性脑卒中IVT 治疗的规范使用。

Abstract：

European Stroke Organisation (ESO) Guidelines on Intravenous Thrombolysis for Acute Ischaemic Stroke (abbreviated form of a name 2021 ESO guidelines) was published in February 2021, which comprehensively and systematically summarizes the latest research progress in intravenous thrombolysis (IVT) for patients with acute ischemic stroke. The new version of the guidelines is an update of the 2008 version of the Guidelines for the Treatment of Ischemic Stroke and Transient Ischemic Attack. There are 48 recommendations in total, providing different patient subgroups, overtime windows, imaging selection strategies. Further the guideline recommended the relative and absolute contraindications of the alteplase and tenecteplase. A new recommendation has been added for thrombolysis in patients with stroke after wake-up or with unknown onset time. This article interpreted the main content and recommendations of the updated points of the 2021 ESO guidelines, including intravenous thrombolytic therapy for patients of ischemic stroke with an onset of

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